Healthcare Provider Details

I. General information

NPI: 1811395213
Provider Name (Legal Business Name): JAKE WILENSKY LPCS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/17/2014
Last Update Date: 12/17/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 HEALING FARM LN
MILL SPRING NC
28756-5808
US

IV. Provider business mailing address

101 HEALING FARM LN
MILL SPRING NC
28756-5808
US

V. Phone/Fax

Practice location:
  • Phone: 828-899-0100
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberLPCS9724
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: